Provider Demographics
NPI:1801783113
Name:WRAY, REGAN (OD)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W AVENUE A
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5215
Mailing Address - Country:US
Mailing Address - Phone:701-426-0053
Mailing Address - Fax:
Practice Address - Street 1:1300 E LASALLE DR UNIT 2
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5716
Practice Address - Country:US
Practice Address - Phone:701-557-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist